State survey process on a Dementia wing

Nancy1 · Apr 6, 2000

My previous position was a nurse manager on a special care dementia unit. The resident were mid dementia for the most part. I went through 3 surveys and I have to say I do not recall it being too bad for the residents. We were able to keep them busy or on another end of the unit.

I know that the survey process is a major stressor for staff. Could it be that the residents were feeding off the staff stress? Or do you have later stage dementia which is a whole other area.

good luck, NA

Sandy W · Apr 8, 2000

I specialize in Alzheimer/Dementia Care. I'm in a Skilled Nursing Facility and the Surveyors were through a week ago. The patients were curious, however, the Surveyors were very aware of the condition of our residents.

RNAC · Apr 8, 2000

Originally posted by j.eaton:
I would like to brainstorm with all nurses who routinely work on a dementia wing. Our longterm care facility recently was surveyed using the new format. I would like to hear your responses on that experience. We had a very negative survey this year compared to our past excellece.Several nurses were unhappy with our survey process.
Also, How do your units cope with the surveyers visiting your units, because new faces are so disruptive to residents.
Do you think that the survey is an accurate measure of resident care on a dementia wing?
How can experienced dementia care nurses impact the state survey process on our units? Thanks to all of you who answer. Keep on doing the great work you do!

One way to impact the survey process is to demonstrate excellent commuications skill using distration and redirection when you assess the resident is being adversly effected by"strange faces". Most new faces can have a positive relationship with a impaired resident with a smile, humor and reminecence. show the survey team how much you know about that person as an individualand teach them something at the same time. We don't have to roll over just because surveyor are present. Discuss with them your observations and ask for an alterative. They do have to do their job.Keep in mind our anxt about them being there also adversly effects resident!

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kayhaw · Jun 3, 2000

I am Nurse Manager on a 30 bed Alzheimer/Dementia unit we have residents ranging from mild to severe dementia. We have not had survey yet this year but for the past 3 years our survey has been great!!! The last 2 years we had 0 deficiencies. The residents did not seem to mind that we had "visitors" they really never paid attention. But I do know that for the staff it was terribly stressful you know never when a resident might fall or have an incontinent episode but we do have a 1CNA to & resident ratio which helps alot. The CNA's keep the residents busy D/T our unit being an activity based unit.

Originally posted by j.eaton:
I would like to brainstorm with all nurses who routinely work on a dementia wing. Our longterm care facility recently was surveyed using the new format. I would like to hear your responses on that experience. We had a very negative survey this year compared to our past excellece.Several nurses were unhappy with our survey process.
Also, How do your units cope with the surveyers visiting your units, because new faces are so disruptive to residents.
Do you think that the survey is an accurate measure of resident care on a dementia wing?
How can experienced dementia care nurses impact the state survey process on our units? Thanks to all of you who answer. Keep on doing the great work you do!

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kim

kayhaw · Jun 3, 2000

Sorry but to add to the cna to resident ratio it is 1to 7. (just slightly embarrased with my typing)

Originally posted by j.eaton:
I would like to brainstorm with all nurses who routinely work on a dementia wing. Our longterm care facility recently was surveyed using the new format. I would like to hear your responses on that experience. We had a very negative survey this year compared to our past excellece.Several nurses were unhappy with our survey process.
Also, How do your units cope with the surveyers visiting your units, because new faces are so disruptive to residents.
Do you think that the survey is an accurate measure of resident care on a dementia wing?
How can experienced dementia care nurses impact the state survey process on our units? Thanks to all of you who answer. Keep on doing the great work you do!

anniek · Oct 18, 2000

Our facility is just starting a Dementia unit and I would be interested in hearing any feed back from anyone with experience with this. It is my understanding that there is no set times for care. How are meal times/bath times/ meds handled in this type of setting.

I know I'll find out first hand soon enough but we are expected to bid for our own positions that we currently hold and when they do the interviews they will pick the mosst qualified applicants, how will you know you are qualified if you've never work in this setting before. I am excited about the prospect of this new unit but I really don't know if I'm the right person for the job. I'v been in nursing (geriatrics) over 20 yrs and I've taken care of dementia residents and behavior problems, but never 48 of them at once.

ktwlpn, LPN · Nov 19, 2000

Originally posted by anniek:
Our facility is just starting a Dementia unit and I would be interested in hearing any feed back from anyone with experience with this. It is my understanding that there is no set times for care. How are meal times/bath times/ meds handled in this type of setting.
I know I'll find out first hand soon enough but we are expected to bid for our own positions that we currently hold and when they do the interviews they will pick the mosst qualified applicants, how will you know you are qualified if you've never work in this setting before. I am excited about the prospect of this new unit but I really don't know if I'm the right person for the job. I'v been in nursing (geriatrics) over 20 yrs and I've taken care of dementia residents and behavior problems, but never 48 of them at once.

In my experience I have found that 48 is too many...I feel that 30 should be the absolute limit and the just increasing the number of staffing will not help.When too many of these pts are in an area together their behaviors tend to trigger each other-and activities are difficult to control in large groups.A unit that size seems like just a corral.I was on a 52 bed unit for several years-what a recipe for disaster(numerous daily incidents among the residents-altercations-often physical)And the higher functioning residents often have little tolerance for the lower functioning individuals..I am on a 21 bed unit now-with awesome techs and a Resident Care Co-ordinator.I do the meds,tx,charting. etc The RCC is there to back me up and to handle the routine mountain of paperwork.We also have "hospitality aides" whom don't do direct care but will do activities and help with meals,give drinks and just be an extra pair of eyes..and we do serve our own meals...the kitchen staff brings the hot plates to us..we have cold cereals and juices etc in our kitchen dining area..This works very well because we know our residents likes and dislikes so well-also cuts down on noise and confusion-and familiar faces are a plus..the mornings are great and that sets the tone for the rest of the day.I set up my med cart in the dining area and as the residents are brought in I give them meds,coffee,drinks, cereal and toast.By the time everyone is up the hot plates are ready and all the staff are with me.This unit is quite new-I have not been on it long but I can tell you it is run the way these units should be...It is great to look forward to going to work everyday ( I had lost that feeling for awhile)Good luck!!

Tim-GNP · Nov 19, 2000

In the case of your question, the best thing you could do for your residents is to make sure that you and your staff continue to act like NOTHING is out of the ordinary. Act as you would act any other day of the year. Residents with dementia are very sensitive to changes in routine.

Having said this, I must emphasize, your unit should be run in a manner that meets DOH requirements, ALL YEAR ROUND. It has never ceased to amaze me... Nursing home staff scurry around during survey time to give the surveyors the 'best show.' As a licensed Nursing Home Administrator, I can assure you... the DOH surveyors know when the best foot is being put forward for them. They are also aware of the special needs of your resident population, they will take into consideration that your unit will not be like other units of your facility.

Be sure that resident's behaviors [although your staff is accustomed to them] are documented in the plan of care, including the ACTUAL interventions your staff uses to address them. The DOH can't issue a citation if they disagree with your interventions, but they can cite you for not having any DOCUMENTED.

I don't know what state you live/work in, I know here in Pennsylvania, the survey process recently underwent revision and as a result is much more in line with the Inquisition versus a useful exchange of dialog between healthcare professionals regarding resident condition. It can be an unpleasant experience many times. Best of luck to you in future surveys.